Abstract
Because acupuncture treatment is defined by the process of needles penetrating the body, placebo needles were originally developed with non-penetrating mechanisms. However, whether placebo needles are valid controls in acupuncture research is subject of an ongoing debate. The present review provides an overview of the characteristics of placebo needles and how they differ from placebo pills in two aspects: (1) physiological response and (2) blinding efficacy. We argue that placebo needles elicit physiological responses similar to real acupuncture and therefore provide similar clinical efficacy. We also demonstrate that this efficacy is further supported by ineffective blinding (even in acupuncture-naïve patients) which may lead to opposite guesses that will further enhances efficacy, as compared to no-treatment, e.g., with waiting list controls. Additionally, the manner in which placebo needles can exhibit therapeutic effects relative to placebo pills include enhanced touch sensations, direct stimulation of the somatosensory system and activation of multiple brain systems. We finally discuss alternative control strategies for the placebo effects in acupuncture therapy.
Highlights
Acupuncture is a therapeutic intervention performed by “inserting one or more needles into specific sites on the body surface for therapeutic purposes” [1]
The probability of making an opposite guess is greater for placebo needles than for placebo pills, which is often explained by patients’ greater expectations
The distinctive touch sensations experienced during acupuncture treatment are substantial, even during the administration of placebo needles
Summary
Specialty section: This article was submitted to Psychosomatic Medicine, a section of the journal Frontiers in Psychiatry. How Placebo Needles Differ From Placebo Pills? The present review provides an overview of the characteristics of placebo needles and how they differ from placebo pills in two aspects: [1] physiological response and [2] blinding efficacy. We argue that placebo needles elicit physiological responses similar to real acupuncture and provide similar clinical efficacy. We demonstrate that this efficacy is further supported by ineffective blinding (even in acupuncture-naïve patients) which may lead to opposite guesses that will further enhances efficacy, as compared to no-treatment, e.g., with waiting list controls. The manner in which placebo needles can exhibit therapeutic effects relative to placebo pills include enhanced touch sensations, direct stimulation of the somatosensory system and activation of multiple brain systems. We discuss alternative control strategies for the placebo effects in acupuncture therapy
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